“The national focus on comparative effectiveness research (CER) is a golden opportunity for the field of integrative medicine and health. This will play out in the focus on health outcomes research (and the need for refined research methods) and in the imperative to educate health professionals to be research literate and be able to utilize this information in their practice. The 2012 International Research Congress on Integrative Medicine and Health (May 15-18, 2012 in Portland) has 2 impressive speakers lined up to address CER (Sean Tunis, CEO of the Center for Medical Technology Policy, and Michael Lauer, Dir of Cardiovascular Diseases, NHLBI at NIH). Although they come from very conventional medical positions, they clearly understand the broader implications related to CAM and Integrative Medicine.”

Submit input on the definition through this link. Submit input on the Tier 1 Pilot Projects through this link.Comment: The potential for the integrative practice community in the comparative effectiveness arena is to directly address a central claim of many integrative practitioners. Many assert, without much organized evidence, that their approach is better and/or more cost effective compared to usual treatment. Yet I have heard that the only outcomes to be compared via PCORI are between approaches which already have a significant evidence base. Since most real world integrative practices haven’t such preliminary research, this could rule out the most significant public health value in comparing integrative practices with usual care. The present definition does not, in itself, seem to preclude such studies. The consumer focus the PCORI Methodology Committee followed would seem also to keep the door open. Input from anyone, again, is open. Take a look and give your input. See the Guiding Principles in the Definition Rationale. (Thanks to Carlo Calabrese, ND, MPH and Haramati for alerting me to these developments.)

Natural products bill seeks to expand HSA payments for supplements

The Family Retirement and Health Investment Act of 2011 (HR 2010, S 1098) would allow US citizens to use their Flexible Spending Arrangement and Health Saving Account (HSA) dollars on dietary supplements and meal replacement products. The bill, backed by Congressman Eric Paulsen and Senator Orrin Hatch 9R-UT), is promoted by the Natural Products Association (NPA). However, in a letter for support sent to its list on July 29, 2011, the NPA shared that they did not believe that the bill would separately pass through the legislative process but could be added as an amendment to another bill that was moving through the process. As of July 29th, NPA had generated over 2000 support letters.

A team of NCCAM-funded health services researchers recently published a substantive editorial in the Journal of Alternative and Complementary and Medicine entitled CAM Practitioners and Accountable Care Organizations (ACO): The Train is Leaving the Station. The authors, led by Mathew Davis, DC, MPH and sometimes Integrator-contributor James Wheedon, DC, take the position that “this is a critical time for the U.S. health care system and an important time for CAM professions to consider how they might fit into an ACO era.” The writers estimate that the “relatively large CAM workforce” amounts to roughly 180,000 licensed CAM practitioners. These will assume one of 3 positions in ACOs: exclusion, partial inclusion or “full participation.” The latter would include meaningful roles in incentive payments via ACA “shared savings” programs. The writers propose areas of potential cost savings from CAM inclusion, noting that the pain-related services with which CAM practitioners are frequently involved make up a good deal of conventional primary care. Ultimately, the authors call for collaboration among CAM professions:

“As policymakers, payers, and stakeholders come together to discuss ACOs, the authors believe CAM professions will have a louder voice as one large group. There are a diverse number of professional organizations both within and across CAM professions that united could influence adoption of CAM into national health care reform efforts such as ACOs. Conversely, should CAM professional organizations continue to act individually, increased competition between CAM professions.”

Comment: The Affordable Care Act in Section 5101 states that health care workforce plans shall include licensed CAM disciplines. However, Section 3502 on patient-centered medical homes was less assertive. The teams in these homes, according to Congress’ language, “may” include chiropractors and members of other licensed CAM disciplines. Credit this team for bringing this issue of how these practitioners “may” be used to the fore. I like and agree with their call for united action. Multidisciplinary vessel for such collaborative work that are noted in the article include the Integrated Healthcare Policy Consortium and the Academic Consortium for Complementary and Alternative Health Care. The authors conclude with a note of urgency: ” … should CAM practitioners and professions fail to get involved in the discussion now, they may not have the opportunity later.”

Homebirth Midwives involved in multiple CMS and Berwick activities

The MAMA (Midwives And Mothers in Action) Campaign reported 3 significant activities related to the Centers for Medicare and Medicaid Services (CMS) on July 26, 2011. First, Mary Lawlor, CPM, the executive director of the Certified Professional Midwives, was invited by CMS administrator Don Berwick, MD to represent the MAMA Coalition at a June 2nd CMS symposium for 40 national health care leaders. The focus was on limiting cost for perinatal caer. MAMA underscored that CPMs were at the table. A week later, MAMA representatives and Jeff Thompson, MD, chief medical officer for Washington State, had a private meeting with Berwick. Their agenda: 1) urge that CMS focus resources on the needs of the majority of childbearing women and infants who are low-risk; 2) increase access to CPMs and birth centers to assure appropriate care for this population that too often suffers the consequences of inappropriate interventions; and, 3) include CPMs and birth centers in performance measurement, data reporting and payment reform initiatives. MAMA also reported that, following their work, the “CMS State Plan Amendment template, containing implementation guidance to state Medicaid offices, specifies that Medicaid reimbursement of birth center provider fees applies to CPMs.”

Comment: Never underestimate the power of a midwife on a political mission. Hours and hours of participation with the most elemental of human activities somehow infuses the typical “how a bill becomes a law” with a distinct birth canal push.

Integrative Care

Glenn Sabin of FON Therapeutics publishes business and marketing resource for integrative centers

Sabin recommends as a next step an “internal audit” of the present program, with these content areas guiding it. FON offers these services. The document concludes with some information on Sabin and his business.

Comment: Sabin is a recent member of theIntegrator Editorial Advisory Board. I am impressed with the work in this document. My guess is that few individuals operating an integrative center or clinic would not benefit from a review of Sabin’s well laid-out white paper. Sabin has an impressive set of partners/clients on his website, including integrative oncology leaders Keith Bock, MD, Gary Deng, MD, PhD and David Rosenthal, MD. Take a look.

Comment: The high-profile Duke center, backed by even higher profile philanthropist Christy Mack, made an exceptional choice in Perlman. In his present position, he has been uniquely positioned among academic integrative medicine leaders given his broad responsibility for allied health. This background, combined with his research and clinical experience, will serve him well in making the most of the interprofessional and institutional opportunities ahead at Duke.

Greenwich Hospital, associated with Yale, terminates integrative program in major cost-cutting move

The integrative medicine program at Greenwich Hospital in Greenwich, Connecticut has been terminated as part of broader budget cuts, according to a July 27, 2011 report in Greenwich Time. The hospital, part of the Yale-New Haven system, announced the layoffs of 36 people as part of an effort to make up for $8.5-million in lost revenues. Roughly half of these were from the hospital’s Center for Healthy Living and the Center for Integrative Medicine. The latter was directed by Henri Roca, MD, LAc who is also a clinical faculty member at Yale and associated with the integrative medicine program there. The hospital’s CEO, Frank Corvino, is quoted: “We think (the IM program) has been a great asset to the community. Unfortunately, it has not been profitable.” A query to Roca netted this brief this formal comment from the hospital:

“Greenwich Hospital continues to believe in the utility and importance of Integrative Medicine and will continue to have an Integrative Medicine Program. We will continue to provide individuals in the Fairfield Westchester communities with quality holistic, integrative, functional medicine care through Dr. Roca’s medical practice and the inpatient services at Greenwich Hospital will continue unchanged.”

Cancer Treatment Centers of America breaks ground on Atlanta facility

An August 1, 2011 Atlanta Journal Constitution article, Cancer hospital brings more treatment options to the Southeast, shares that Illinois-based Cancer treatment Centers of America (CTCA) has broken ground on a new 50 bed facility outside of Atlanta. CTCA’s entrance into the Georgia took a legislative battle, according to the story. Antagonism toward CTCA was expressed by Monty Veazey, president of the Georgia Alliance of Community Hospitals: “When you have someone who comes in and cherry picks the system, it hurts all.” CTCA eventually agreed that it wouldn’t compete heavily in the local market. Over 2/3 of CTCA’s patients must come from out-of-state. In addition, CTCA must guarantee that at least 3% of its care will be charity care. This is higher than CTCA’s usual level but a customary rate for its competitors. The firm already operates hospitals in Chicago, Tulsa, Phoenix and Philadelphia, and an outpatient center in Seattle.

Comment: The negotiations parallel a similar battle CTCA unsuccessfully faced in its effort to create an inpatient facility in the Seattle area. See related Integrator feature here. CTCA’s low level of charity care was again an issue. There is something about hospitals fighting over the harvest of oncology patients that is fundamentally distasteful.

A new organization called Spa 4 The Pink (S4TP)has established a fund at the Center for Integrative Medicine at the University of Colorado. S4TP works through various alliances such as this one at the Colorado integrative medicine program to “touch cancer survivors lives by providing them with complimentary skin care products, oncology spa services and education on how to cope one day at a time with changing skin and body issues related to cancer treatment.” The Colorado-based not-for-profit organization was founded by business woman Julie Bach. Denver Nuggets Coach George Karl stumps for integrative cancer careA note posted July 26, 2011 on the Denver Nuggets website shares that Nuggets’ coach George Karl, a two-time cancer survivor, is fundraising for integrative medicine. The beneficiary is the Cancer Care Initiative that help patients balance “treatment methods such as radiation and chemotherapy with integrative methods such as acupuncture, meditation and yoga” that are “not covered by insurance.” Here is Karl:

“I think there are nutritional people who are being ignored and people that have the holistic approach who are being ignored. It’s crazy that I can take the most powerful pain drugs and go to the pharmacy every week and not get charged one dollar. Yet I can’t go get a massage without paying out of my pocket. It’s ludicrous.”

“We view the core foundational aspect of holistic health practice to be our own work on self-healing. Our ability to effectively serve our fellow human beings inevitably emanates from knowing the territory within ourselves. Thus, we see the AHMA’s core mission as furthering that ideal, helping holistic practitioners heal in order to truly be present for others, enhancing our capacity to ‘pay it forward’.”

On October 14-16, 2011, AHMA will further this mission with a The Healer Within seminar at the Institute for Noetic Sciences retreat center in Petaluma, California. AHMA executive director Steve Cadwell notes that AHMA and its partners in the successful iMOSAIC conference have decided to hold their next joint conference as a group of 4 organizations in 2013.

Comment: This focus for AHMA tracks back to the organization’s origins 30+ years ago. Then the organization was a support for the individual holistic doctors who were beginning to pop up here and there in practice, but were not yet connected. The direction appears to represent a retreat from engaging a broader policy role such as has been urged by some of its board members in recent years.

Regarding the iMOSAIC conference, two of the 4 partners, the American Academy for Environmental Medicine and the American College for Advancement in Medicine, have chosen to jointly hold a conference this year, on November 16-20, in Portland, Oregon. Called Exchange 2011, the conference is posted via the iMOSAIC web address.

The Competencies Profile section has the following sub-components: Yoga Foundation; Contemporary biomedical and psychological knowledge; Knowledge of teaching and therapeutic skills; Application; and Professional practice. The development of IAYT’s Proposed Education Standards was led by IAYT’s 14 person Standards Committee.

Comment: The value in setting standards for the consuming public and for prospective members of any field is inestimable. At the same time, as Carlo Calabrese, ND, MPH observed 20 years ago during the naturopathic educators’ process toward a nationally-recognized standard, any time you create standards you create pain. Congratulations to the IAYT for its steady, inclusive process. One cannot help but note that these standards are announced not only as a “draft” but also as “proposed.” This is strong advertising of openness to input from the Yoga therapy educational community.

American Massage Therapy Association reviews its broader healthcare relationshipsIn an article in its e-newsletter, the American Massage Therapy Association offers a piece entitled AMTA’s Health Care Relationships and Their Impact on the Massage Profession. Among the membership organization’s listed involvements are with the Penny George Institute, the AMA CPT coding operation, National Center for Complementary and Alternative Medicine, Integrated Healthcare Policy Consortium and Academic Consortium for Complementary and Alternative Health Care. Chris Studebaker serves as the organization’s Government and Industry Relations Manager.

The IHPC website shows growth in the organization’s Partners in Health program. Among the new logos on the Partners page are those from the American Association of Naturopathic Physicians (AANP), Sojourners Community Health Clinic, International Chiropractic Pediatric Association and the American Sustainable Business Council. Not listed but also a Partner is the American Massage Therapy Association (see above). According to individuals close to the organization, the Partners program, with its linked and interlocking IHPC board positions, may now have as secure a base as the organization has had since it was founded a decade ago. A significant new force has been the increased commitment of Bastyr University through Greg Goode, the director of Bastyr’s Center for Policy and Leadership.

Comment: IHPC is the little engine that could. With the AANP decision to join, the national organizations for naturopathic medicine, acupuncture and Oriental medicine, massage therapy and certified professional midwives are each involved. Missing from a full house of the distinctly-licensed CAM fields is the American Chiropractic Association. Two significant chiropractic organizations are partners, however: the pediatric group noted above and Palmer College. The bigger missing pieces among IHPC’s partners are the integrative and holistic medical doctors and nurses. Interestingly IHPC’s chair, Len Wisneski, is a medical doctor. As noted elsewhere in this Integrator, IHPC had an important recent influence when its definition of “integrated health care” was used, word-for-word, in the National Prevention Strategy.

The University of Western States (UWS) is partnering with the Oregon Chiropractic Association and the American Chiropractic Association to offer a symposium on primary care. The educational sessions will immediately follow the ACA House of Delegates meeting. Subject matter ranges from irritable bowel to hypertension to otitis media to women’s health and gastrointestinal issues. University of Western States, led by president Joe Brimhall, DC, is a leading broad-scope chiropractic educational program.

Comment: The philosophical and educational splits in chiropractic, which make some recoil from the phrase “chiropractic medicine,” make the broad scope primary care positioning a challenge. I have often wondered what US back care outcomes would look like if chiropractors positioned themselves triage articles to both conventional and other CAM practitioners as “primary care for back pain.” Given the very high percentage of primary care patients who come with back-related issues, an expanded use of chiropractors in this primary care capacity alone could substantially relieve pressure on the primary care system.

The Midwifery Education Accreditation Council (MEAC) is seeking a new executive director. The 20-year-old organization, recognized by the US Department of Education as the accrediting body for direct-entry (non-nurse) midwifery programs, has played a leading role in the maturation of the profession of Certified Professional Midwives. MEAC presently accredits 10 schools. The executive director position is expected to take 20-30 hours a week. Salary will be negotiated. The MEAC office is presently in LaConner, Washington, but could be moved to suit the right person. For information, contact info@meacschools.org.

Comment: Whoever lands this position will not only be connected to a tremendous community of health professionals. This person will also have access to the mentoring of Jo Anne Myers-Ciecko, MPH, the outgoing executive director. Myers-Ciecko, a long-time colleague, will be available for up to 2 years to support the acculturation of the new executive. Myers-Ciecko writes: “MEAC celebrates its 20th anniversary this year and I am the last of the original founding board members still involved in the governance or administration of the organization. A new era in professional midwifery and education is dawning – we look forward to finding a gem of a person who will bring new expertise, energy and leadership to our dear MEAC.”

Media

Medscape asks: “Is CAM always a Scam?” and finds that 33% of MDs support patients’ use of alternatives

Medscape published on July 11, 2011 a summary of medical doctor comments on a subject entitled Is CAM always a Scam?” The report from Medscape’s Physician Connect Discussion Board (reserved for MD/DO/DDS-only) offers the gamut of opinion on CAM. The discussion was stimulated by a neurologist asking: “How do you counsel patients interested in complementary or alternative therapies?” An associated Medscape poll found that 31% of respondents supported their patients’ use of alternate paths of treatment, 18% discouraged it “as a general rule” and a 38% advocated “telling [patients] there is little evidence one way or the other and leaving it open.”

Addendum: Last spring Forbes hosted another, blog-based dialogue on a similar topic in which Integrator columnist Taylor Walsh was among the participants. The discussion was stimulated by an opinion piece by polarizing anti-CAM academic Stephen Salzberg entitled “Why medical schools should not teach integrative medicine.” Salzberg receives quality criticism from Walsh among others. One theme in the discussion thread was whether complementary or integrative medicine would ever “go away.” Walsh ends his comments: “This trend will be ‘reversed’ just after the Internet is reversed.”

Conferences

Two from the Consortium of Academic Health Centers for Integrative Medicine

The Consortium of Academic Health Centers for Integrative Medicine is planning its inaugural One-Day Research Symposium in Integrative Medicine and Health. The symposium will be held in Los Angeles, California on Wednesday, October 26, 2011. According to a note from Ather Ali, ND, MPH, one of the organizers, the goal is to “facilitate a gathering where researchers from a variety of disciplines, at all levels of training, will be able to share their work and connect.” Special attention will be given to research from early-career scientists, students, trainees and fellows. The Symposium will be a peer-reviewed scientific meeting with oral and poster sessions. Keynote speaker will be Josephine Briggs, MD, Director of NCCAM. Submissions due August 15, 2011. Registration fees waived for presenting authors whose abstracts are accepted for oral presentation. www.imconsortium.org/researchday/index.htm

The most significant research conference for the integrative practice field, Integrative Medicine and Health International Research Conference, will take place in Portland Oregon May 15-18, 2012. Key dates for this conference are: submission of research abstracts and proposals ofr session opens online (Sept 1, 2011); deadline for proposals for sessions (Oct 15, 2011), deadline for research abstracts (Nov 15, 2011); early bird registration deadline (March 16, 2012). Website is here: www.IMConsortium-Congress2012.org

The 3rd Heal Thy Practice: Transforming Primary Care conference will be held on November 4-6, 2011 at the Renaissance Long Beach Hotel in Long Beach, California. The unique conference is sponsored by Holistic Primary Care and led by the publication’s founding editor Erik Goldman. Steven Masley, MD is conference chair for a program that includes both top-flight content on clinical topics from the likes of David Perlmutter, MD and James Gordon, MD and also a focus on marketing and use of the internet in building a clinical business. Integrative medicine medical-legal expert Alan Dumoff, JD, MSW will also present. The focus of the conference is, according to Goldman, “new practice models that put the health back in health care.” Conference co-founder and Holistic Primary Care publisher Meg Sinclair explains:

“We started this because we we’ve met many physicians who are sincerely interested in holistic approaches, and want to practice in a more integrative way. But they can’t figure out how to implement these approaches in their practices, and they’re frustrated. Most holistic/preventive stuff isn’t covered by insurance, so doctors who want to go that way usually need to learn new business skills and practice models. We knew many doctors who have very successful integrative practices, so we thought it would be a great idea to bring them together and create a forum about practice transformation.”

Comment: I credit Goldman and Sinclair for not only naming the elephant in the room when they started this conference (economic success for those choosing holistic primary care) but assiduously exploring means to tame it. Take a look at the agenda. Looks like plenty of take-home strategies.

People

In Memoriam: Konrad Kail, ND (1949-2011)

Konrad Kail, PA, ND was both pillar and energetic driving force behind the modern resurgence of the naturopathic medical profession and, as such, the emergence of natural medicine into U.S. healthcare delivery. An excellent obituary from Erik Goldman, a friend of Kail and editor of Holistic Primary Care, details some of his contributions as does this Integrator piece honoring Konrad. Among these: chair of Arizona’s naturopathic board; co-founder and chair of the board of Southwest College of Naturopathic Medicine (SCNM); 3rd president of the American Association of Naturopathic Physicians; awarded in-office researcher; product developer; founding member of the NIH NCCAM’s National Advisory Council and NCCAM’s liaison to the NIH’s integrative cancer initiative. Paul Mittman, ND, current president of SCNM, wrote to the his community that Kail was “bigger than life, one whose accomplishments would fill the resumes of 10 people.”

Comment: Konrad’s 1990-1992 term as AANP president coincided with 2 of my 3.5 years as AANP executive director. For those 2 years, he and I spoke virtually every Tuesday and Thursday during his clinic noon hour, and often many more times during the week as we strategized on how to grow that organization, and profession. We worked hard and played hard throughout. Check out the story about the herb that grows in Grizzly dung in my remembrance – plus the incredible list of Kail’s contributions.

Edzard Ernst, MD begins early retirement with a tongue lashing for Prince Charles

The prolific United Kingdom-based writer-researcher Edzard Ernst, MD, PhD blasted Prince Charles as a “snake-oil salesman” in parting comments related to his early retirement from his position as chair for complementary medicine at the University of Exeter. In a feature in the Guardian, Ernst makes clear that he’ll be back. He is planning another book. Ernst and Prince Charles, a strong supporter of homeopathy and of alternative treatments, have been embattled since at least 2005. In recent years Ernst has moved from antagonism toward homeopathy to writing against the dangers of chiropractic and acupuncture. Ernst leaves the university as professor emeritus.

Clem Bezold, PhD honored by World Future Society for life-time service

Comment: Having had the privilege of knowing and working with Bezold, and being mentored by him, over the past dozen years, I can add that his distinguished service is not just to futurists but to the future itself. Bezold uses the concept of the “preferred future” in his work. Participants examine the characteristics a preferred future would have, and the steps that would be expected to be associated with such a future. It’s not a bad handle for anyone mission-focused work. What are you doing today? Oh, working toward a preferred future. Thanks and congratulations, Clem!

ACCAHC adviser John Gilbert, PhD honored with selection to the Order of Canada

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As the editor of IntegrativePractitioner.com, Lindsay combines her background in digital journalism with her experience in planning the content Integrative Healthcare Symposium conferences. She is an avid traveler and loves to explore new cultures and languages. As a researcher and writer, she embraces the opportunity to explore topics and conversations that are both challenging and exciting, which brought her to the world of integrative medicine. Working together with colleagues and peers across the integrative healthcare community, she is eager to help stimulate important conversations and grow the movement.